Der Internist
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Asthma, chronic obstructive pulmonary diseases, interstitial lung diseases and myocardial dysfunction are the leading diagnoses of patients with dyspnoea. Acute dyspnoea appears suddenly or within a few hours and is caused by a relatively limited number of conditions some of which can be life-threatening. Therefore, it is of utmost importance to identify the cause of dyspnoea immediately. Once found, the disorder is treated according to the guidelines for the underlying disease.
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Acute chest pain is the leading cause of hospital admissions worldwide and absorbs extensive financial and hospital resources for diagnosis and management. A missed diagnosis of acute myocardial infarction is still associated with a poor outcome and represents one of the most common reasons for lawsuits in the USA. The present article gives a summary on the features of cardiac and non-cardiac chest pain, provides an overview of diagnostic algorithms, and points out the important differential diagnoses.
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The flood disaster in the region of the Oder and Elbe Rivers or the disaster in Eschede, Kaprun, or Ramstein make us aware that disasters not only occur in distant regions of the world but also in our latitudes. They do not follow any rules; no one can predict the location, time, or type of a disaster. However, this lack of concrete predictability should not lead to our being unprepared to respond to catastrophic events. ⋯ Dealing with disasters necessitates cooperation between numerous organizations and people. This requires clearly structured facilities for information, communication, and decision making as well as a well-defined process flow. In addition to basic planning and practicing of these processes for medical management of catastrophes-such as searching for and rescuing victims, triage, performing life-saving emergency procedures, definitive medical treatment, and transfer of patients-establishing structures for disaster preparedness is indispensable to meet the demands of mass cases of ill or wounded individuals.
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Acute abdomen is not a disease entity on its own but describes a critical state of the patient which can be caused by numerous diseases. The surgeon and internist have to apply an interdisciplinary approach to enable a rapid decision on whether immediate laparotomy is mandatory. ⋯ This review is mainly focused on diseases which may present as acute abdomen but for which surgery is usually not indicated, such as acute pancreatitis. Furthermore, one also has to consider rare diseases in which laparotomy would clearly be a mistake, such as acute intermittent porphyria or intestinal pseudo-obstruction.
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Despite 50 years of clinical experience with vitamin K antagonists such as phenprocoumon or warfarin, many clinicians are uncertain how to start treatment, deal with overdose or bleeding complications, and how to bridge anticoagulation when treatment with vitamin K antagonists is interrupted. Patients with overdose of vitamin K antagonists or bleeding complications are treated with vitamin K, prothrombin complex concentrates (PCC), or recombinant factor VIIa. Rapid reversal of anticoagulation is only achieved by using PCC or recombinant factor VIIa. ⋯ For elective surgery, treatment with vitamin K antagonists is paused and vitamin K given either orally or intravenously. Unfractionated or low molecular weight heparin is given when INR levels are below therapeutic range. Patients with contraindications to heparin may be treated with alternative anticoagulants such as danaparoid, lepirudin or fondaparinux.